Research & Sources

National health spending reached $5.3 trillion in 2024 (18.0% of GDP)

Health spending projected to reach 20.3% of GDP by 2033

Average employer-sponsored family premium: $25,572 (2024)

44% of adults say health care costs are difficult to afford

41% of adults reported medical or dental debt (2022)

23% of working-age adults are underinsured

75% of Medicare Advantage care denials overturned when fully reviewed

13% of denied MA prior authorization requests met Medicare coverage rules

20% of in-network claims denied on the ACA marketplace (2024)

Fewer than 1% of denied in-network ACA marketplace claims were appealed

Only 5% of reported in-network ACA marketplace denial reasons were medical necessity

53 million prior authorization determinations in Medicare Advantage (2024)

93% of physicians report prior authorization delays access to necessary care

Internal appeal outcomes vary by market, plan, and documentation

External review may be available after an internal appeal

Prior authorization denials often turn on documentation and plan-rule details

CMS 2026 rule: 72-hour urgent / 7-day standard prior auth decisions required

1.2 million No Surprises Act IDR disputes filed in H1 2025 — doubled YoY

Final bill $400+ over Good Faith Estimate triggers Patient-Provider Dispute Resolution

45% of insured adults received unexpected bills for services they believed were covered

27 million people disenrolled from Medicaid after redeterminations resumed

69% of Medicaid disenrollments were procedural (not eligibility-based)

Enhanced ACA premium tax credits expired January 1, 2026

92.0% of people had health insurance for some or all of the year (2024)

92.3 million people live in primary care shortage areas

137.1 million people live in mental health shortage areas

Projected 141,160 FTE physician shortfall by 2038

76.4% of adults had at least one chronic condition (2023)

51.4% of adults had multiple chronic conditions (2023)

Over-65 population expected to be 21% of total by 2040

Medicaid LTSS users: 9.7 million; expenditures: $228.6 billion (2023)

Americans owe an estimated $220 billion in medical debt

31 million Americans borrowed $74 billion in 2024 to pay for healthcare

100 million Americans carry medical or dental debt

Estimates put medical-bill error prevalence between 49% and 80%

61.8% of people who negotiated a problematic medical bill reported a lower price

Medical collections under $500 were removed from major U.S. credit reports under a 2023 credit-bureau policy

Nonprofit hospitals required to have financial assistance policies (501(r))